As the current swine flu outbreak moves closer to a full-blown pandemic, now seems like a good time to reflect upon a forgotten chapter in modern history: the flu pandemic of 1918. While often referred to as the Spanish Influenza or The Great Influenza, the origins of the 1918 H1N1 flu strain are not fully known, but some have theorized it originated in Kansas. The 1918 outbreak was especially deadly as pandemics go, killing anywhere from 20 to 50 million worldwide. It spread quickly, partly because of the First World War and all the soldiers moving en mass between and across continents. The 1918 flu also had a high infection rate — around 50 percent — and the symptoms were severe, caused by something called a cytokine storm, where too many immune cells are activated in a single place causing a positive feedback loop (basically an overreaction of the body’s immune system). This is why the 1918 pandemic was so deadly for the young and healthy. The current swine flu is eerily similar, striking down the young folks rather than the elderly.

What made the 1918 pandemic so startling was the speed to fatality, the seasonal disconnect (summer and fall instead of winter), and the fact that healthy individuals were more likely to died from infection. Another oddity of this strain of flu was the severity of symptoms. One of the first signs of illness was an usual blue tint to the victims face. Death would often come quickly after massive amounts of fluid built up the victim’s lungs, causing them to drown. Others still suffered from violent diarrhea, resulting in fatal blood loss. All and all, the 1918 flu rivaled such modern day viruses like Ebola in general nastiness.

One of the major differences between the 1918 and the 2009 pandemic is governmental response. In 1918, governments around the world took few steps to warn citizens. In the US, the feds downplayed the threat because people were already stressed about our entry into WWI. Few actions, like isolating the infected, were taken to minimize the spread. In fact some steps the government took actually exacerbated the problem — like the massive army recruitment drives bring thousands of young, healthy men together. The 1918 outbreak is also referred to as the forgotten pandemic by historians, since few Americans have any knowledge of it. This has often been attributed to the fact that a disproportionate number of victims were young adults and because of the rapid spread. The pandemic was also overshadowed by WWI and the horrors that war produced.